/ PSS Central Institute of vocational education
(A Constituent Unit of NCERT)
Shyamla Hills, Bhopal (M.P.)462013
(0755-2704100) and
Advertisement No.02/2015
Note : Before filling this form, please read the detailed advertisement carefully.
  1. Sector/s
/
  1. CATEGORY
(UR/SC/ST/OBC) /
  1. GENDER
/
  1. NATIONALITY

1
2
3
  1. Candidates Name (In capital letters)(for Sl No. 5 and 6 keep one box blank between name and surname)
  1. Father’s/Husband’s Name (In capital letters)
  1. Address

Name
Father/Husband’s
Name
Address:
State / Affix Photograph here
Pin
Mobile Number
E- Mail id

8. Date of Birth 9. Age as on 01.01.2015

D / D / M / M / Y / Y / Y / Y / Y / Y / M / M / D / D

9.Educational/Professional Qualification (Starting from Class Matriculation onwards)

Examination
Passed / Discipline/Specialization/
Subject / Board/
University / Year of
Passing / Duration of Course / % of marks / Division

10. Experience, if any, starting from previous to present Total Experience :____ Years______Months

Employers Name and Address (Also indicate whether Central Govt./State Govt./Autonomous Bodies/Private Sector) / Designation / Scale of pay/Salary per annum / Length of Service / Total Experience in Years / Nature of work, in brief
From / To

11.Please mentionany disciplinary proceedings, criminal case, enquiry, etc. against you is pending.

Yes/No

If yes (please mention)

12.Justify how you are eligible for developing Curriculum and Courseware in your Sector.

13. DECLARATION TO BE SIGNED BY THE CANDIDATE

I hereby certify and declare that (1) I am an Indian National, (II) I have read the provision given the Advertisement (iii) All statement made and information given by me in this application are true, complete and correct to the best of my knowledge and belief. In the event of any information or part of it being found false or incorrect at any stage action can be taken against me and my candidature/engagement shall automatically stand cancelled/terminated (iv) I further declare that I fulfill all the conditions of eligibility regarding age, educational, professional qualification etc. prescribed for the post applied for.

Place :

Date: (Signature of the Applicant)